Overview
The spiral cord is a pathological cord in Dupuytren disease that is particularly important because it alters the position of the digital neurovascular bundle.
Formation
The spiral cord is formed from diseased longitudinal structures including elements of:
- Pretendinous band
- Spiral band
- Lateral digital sheet
- Grayson ligament
As the cord contracts, the neurovascular bundle is progressively displaced.
Neurovascular displacement
The digital neurovascular bundle normally lies deep and lateral to the pathological cord. With development of a spiral cord it becomes central and superficial, placing it at increased risk during fasciectomy.
Surgical importance
- Identify the neurovascular bundle before dividing or excising the cord.
- Expect the bundle to deviate from its usual course near the MCP and proximal phalanx.
- Dissection should proceed under direct vision with careful control of the diseased fascia.
Dupuytren disease context
Dupuytren disease causes progressive fibroproliferative thickening and shortening of palmar fascia. The ring and little fingers are most commonly affected.
Treatment is based on functional contracture rather than the presence of a nodule alone and may include needle fasciotomy, collagenase where available, limited fasciectomy or dermofasciectomy in selected cases.
References
- Orthobullets. Dupuytren's Disease.